Coffee - Functional Food and Medicinal Herb

Coffee–Functional Food
and Medicinal Herb
Chris D. Meletis, N.D.
A simple chemical analysis of whole green and roasted coffee
beans shows their chemical constituents and the metabolic
changes that occur during processing, preparation, and ingestion,
Coffee(Coffea arabica) is the second-largest worldwide com- all of which warrant further investigation.
modity, overshadowed only by crude oil. Without ques-
An illustrative case in point is the significant niacin content that
tion, coffee is the most frequently consumed functional
is formed from trigonelline during the roasting process, produc-
food around the globe: In the United States alone there are 108
ing between 2 and 80 mg of niacin per cup of coffee.5 Thus,
million coffee consumers who spend $9.2 billion in the retail sec-
although niacin is not abundantly present in the nonroasted bean,
tor and $8.7 billion in the foodservice sector each year.1 And these
processing itself generates spikes in niacin content that depend
numbers represent only a fraction of the global population, large
upon bean quality and the roasting and preparation processes.
numbers of whom incorporate coffee as a staple in their cultural
This raises the question of what other changes occur during the
practices.
roasting process that might augment the therapeutic benefits of
Coffee also has a rich medical history. The therapeutic benefits
the coffee bean further.6 Beyond its phytochemical components,
of coffee are now supported by a rapidly growing and significant
this beverage also provides an array of minerals and other nutri-
level of scientific validation. The epidemiologic significance of
ents. A single cup of coffee can provide 8 percent of the daily
the research in the field of coffee cannot be overstated, consider-
intake of chromium7 as well as being a significant source of mag-
ing the prevalence of coffee ingestion among the peoples of the
nesium.8
world.
It has also been reported that the coffee brewing process can
Beyond the cultural and medical ramifications of coffee con-
help remove toxic metals, such as lead, from contaminated water
sumption, the fact is that coffee is big business with huge social,
sources.9 There is little question that over the next decade the
environmental, and economic impacts. The National Coffee
field of coffee research will flourish and yet-to-be-identified bio-
Association reported that in 2000 54 percent of the U.S. adult
genic substances and their therapeutic indices will be elucidated.
population drank coffee.2 The average consumption per capita in
the United States is approximately 4.4 kg annually at a cost of
Analyzing the Analysis of Coffee
$164.71 per individual. Among U.S. coffee drinkers the average
consumption is 3.1 cups of coffee per day.2
The investigation of the therapeutic effects of coffee has
These statistics provide compelling motivation to investigate
endured the same shortcomings that plague most of the whole-
the consequences of such large-scale consumption of this bever-
plant research paradigm. The concept that “one size fits all” sim-
age. What follows is a review of some of the most recent
ply does not apply to botanicals in the same manner that it does
research into the active constituents and potential clinical appli-
to isolated drug therapies. The standard scientific model, in its
cations of the functional food that is humbly known as the cof-
attempt to apply a reductionistic methodology, has generally
fee bean.
failed to consider coffee as a whole plant complex that is not
divisible into single chemical isolates.
Coffee-Bean Chemistry
Just as studying the benefits of beta-carotene is not the same as
studying the benefits of eating a carrot, studying the benefits
Coffee’s bioactive profile contains many of the most important
(and downfalls) of caffeine is not the same as understanding
constituents known to exist within functional foods: flavonoids
what it is that makes coffee a useful medicinal plant. Divergent
(catechins, anthcyanins); caffeic acid; and ferrulic acid.3 Addi-
thinking, as opposed to a convergent analysis of medicinal
tional biologically active components found in coffee include
plants, provides the foundation for the discovery of new and
nicotinic acid, trigonelline, quinolinic acid, tannic acid, pyrogallic
synergistic constituent blends that may make an impact on the
acid, and caffeine.4
physiology of human health.
7

---

8
ALTERNATIVE & COMPLEMENTARY THERAPIES—FEBRUARY 2006
Namba and Matsuse reported that coffee can lessen the physio-
Selected Active Constituents and Classes of
logic damage that may arise during viral infections.14 Antibacteri-
Active Constituents in Coffea arabica
al properties have been reported to arise from caffeic acid,
chlorogenic acid, and protocatechnic acid, all of which are present
Agmatine
Magnesium
in coffee.15 Antiadhesive properties have been attributed to roast-
Anthocyanins
Nicotinic acid
Caffeic acid
Polyphenols
ing-induced molecular changes (e.g., that roasting helps prevent
Caffeine
Pyrogallic acid
the attachment of bacterial fimbriae to the mucosal membranes).
Catechins
Quinolinic acid
In one study, antiadhesive properties were associated with a
Chlorogenic acid
Serotonin
specific influence on Streptococcus mutans.16,17 S. mutans is fre-
Chromium
Soluble fiber
quently associated with chronic oral pharyngeal infections,
Diterpene
Spermidine
Ferrulic acid
Tannic acid
including recurrent tonsillitis. Although clinical studies have yet
Flavonoids
Trigonelline
to be conducted, applying the concept of antiadhesive properties
by gargling with coffee to decrease virulence and host burden
may hold clinical promise.
This concept is not foreign to the coffee research community,
As a clinical note, when considering the concept of antiadhesive
which has had to be introspective as it investigates why, exactly,
therapeutic interventions, it may be helpful to recall that a promi-
research findings in the field remain inconsistent and at times
nent mechanism that supports the use of the cranberry in the treat-
lack reproducibility.
ment of bladder infections is the berry’s antiadhesive properties.
Conclusions thus far suggest that variations in the concentra-
Further research is needed to elucidate the antimicrobial effects
tion of caffeine and other active constituents, as well as the total
of coffee; this author would also propose investigation into the
volume of fluid consumed, has contributed to the variations in
effects of naturally occurring tannins in coffee on the resistance of
the accuracy of clinical findings. Epidemiologic studies reflect
mucous membranes to penetration by infectious microbes.
these “discrepancy factors.”10 The scientific literature reports
that confounding variables lead to conflicting results in the
Coffee’s Antioxidant Power
analysis of the impact of coffee on health.11 In short, removing
culture, diet, and lifestyle from the analyses generates data that
It is important to note that there is no such thing as a represen-
are not grounded in the traditional applications of coffee within
tative cup of coffee with a specific chemical profile. The origin of
a given populace, thus diminishing the studies’ clinical rele-
the bean; the agricultural practices that grew it; the variations
vance.
between species; and the handling, processing, brewing, and pre-
In reviewing the diversity of international coffee consumption,
ferred ingestion practices all serve as confounding variables
factoring in bean-roasting, brewing, and preferred methods of
when trying to perform a chemical analysis on a cup of coffee.
ingestion are all essential when seeking to determine the therapeu-
However, one important control factor regarding the achieve-
tic effects of the coffee bean.12 In reviewing eight European and
ment of maximum antioxidant levels in coffee has been shown to
U.S. brewing techniques and roasting methods, wide variations
occur from intermediate roasting techniques.18,19
were noted. Brewing techniques alone result in differing levels of
Coffee is a rich source of antioxidants, including those derived
active constituents, such as diterpene levels, which consequentially
from the hydroxycinnamic acids family (caffeic, chlorogenic,
have an impact on therapeutic breadth and efficacy.13
coumaric, ferrulic, and sinapic acids), flavonoids, and polyphe-
This article highlights the positive benefits of coffee; yet, as
nols.20
with all herbal products, one size does not fit all. Therefore,
Beyond the innate antioxidants found in unprocessed coffee
those people who have underlying health conditions—such as
beans, processing byproducts have yielded newly formed antiox-
high blood pressure, fibrocystic breast disease, cardiac arrhyth-
idants such as the recently discovered “silverskin,” which is the
mias, peptic ulcers, anxiety, insomnia, or any other condition
innermost skin of the coffee fruit body. Silverskin clings to the
that might render one sensitive to the active constituents of cof-
dried coffee bean until it is removed by polishing or is liberated
fee—should probably be advised to avoid using coffee as a
during roasting, and represents yet another new, functional
medicinal food.
ingredient in coffee that contains both soluble fiber and antioxi-
And, as with all herbal products, people who want to avail
dant activity.21
themselves of the benefits of coffee should be advised that work-
It has been determined that water is the best method for
ing closely with one’s health care provider is essential.
general antioxidant extraction. When four solvents were
u s e d — w a t e r , m e t h a n o l , e t h a n o l , a n d n - h e x a n e — w a t e r
Coffee’s Antimicrobial Effects
extracts produced the highest yields of antioxidants and the
best lipid-peroxidation protection. The water extract demon-
Reports of the use of coffee as folk medicine for treating sore
strated a particularly high protective effect against oxidative
throats, colds, and other ailments abound. These empirical obser-
damage to proteins. The water extract also showed superior
vations are now supported by a growing body of scientific litera-
free-radical scavenging, generally reducing the ability and
ture suggesting that antibacterial and antiviral properties may be
capacity to bind ferrous ions thus reflecting its dynamic
present in coffee.
capacity as both a primary and secondary antioxidant. The

---

ALTERNATIVE & COMPLEMENTARY THERAPIES—FEBRUARY 2006
9
concentration of flavonoids and polyphenolic compounds—
both of which are commonly found in coffee—were 8400 and
20,4000 ppm, respectively.22
When evaluating the antioxidant properties of coffee, higher
activity levels appear in vivo, after the coffee has been consumed,
because colonic microflora metabolize most of the dietary phe-
nols and therefore significantly increase antioxidant activity.23
When reviewing the coffee literature, additional consideration
must be taken into account regarding whether the coffee is con-
sumed filtered or unfiltered. Consumption of unfiltered coffee
(as in Italy) has been shown to increase plasma glutathione.24
As an example of naturally occurring synergy, chlorogenic acid
undergoes conjugation with glutathione, increasing the protective
mechanism of both of these substances.25 Revealing more about
the unique properties and chemical profile of coffee, research has
demonstrated that the melanoidins in coffee produce higher
antioxidant activity than the melanoidins present in beer.26
Coffee (Coffea arabica).
This may all be academically interesting but what role might
the antioxidant properties of coffee play in maintaining health? It
has been concluded by the international scientific community
that a Westernized diet is devoid of sufficient antioxidants, in
teine levels and improvements in vasoreactivity.32 The ability of
large part the result of inadequate intake of fresh fruits and veg-
GCBE to make an impact on these two independent risk factors
etables. It appears, however, that coffee may help fill this “antiox-
for cardiovascular disease progression is significant.
idant void,” serving as a primary source of dietary antioxidants
Other studies have shown that regular coffee intake has the
in Germany,27 Spain,28 the United States,29 and probably many
potential to decrease the susceptibility of low-density lipoprotein
other countries.
to oxidation and decrease malondialdehyde levels.33 Further
research has examined the ability of caffeine (250 mg two times
Coffee, Asthma, and Bronchitis
per day) to lower the incidence of cardiovascular events in
patients with type 1 diabetes, demonstrating a positive effect.34
Asthma and other pulmonary ailments continue to grow in
(For another view of coffee and heart health, see Caffeine and the
prevalence in the United States. Interestingly, coffee rich in
Heart in News You Use.)
methylxanthines appears to confer a protective effect for main-
taining healthy airway function. This is not surprising because
Coffee’s Impact on Cognition and Mood
another xanthine, theophylline, has been used over the years as a
prescription asthma medication.
A popular use of coffee—particularly in vogue among college
Studies have shown that regular consumption of coffee
students—is drinking it to enhance one’s ability to assimilate vast
reduces symptoms of asthma and lessens the probability of expe-
amounts of knowledge within finite periods of time. According
riencing bronchial asthma.30 Further pulmonary applications
to recent findings, consuming a few cups of coffee can indeed
include using coffee to treat both acute and chronic airflow
strengthen information processing and enhance the ability to
obstructive disease in smokers.31 Coffee for treating acute and
monitor for erroneous outcomes.35
chronic bronchitis may prove to be a worthy area for further clin-
The physiologic effects of challenging mental capacity
ical investigation.
increased catecholamine levels, and coffee drinking increased the
concentration of both adrenaline and noradrenaline further, pro-
Coffee and Cardiovascular Disease
viding “in the moment” clarity. There was also an increased uri-
nary excretion of adrenaline and noradrenaline after the
In the United States, cardiovascular disease leads to one
ingestion of a single cup of coffee.36
death every 33 seconds and contributes to 70 percent of total
Another study tested the effects of spiking coffee with addi-
deaths annually. This makes identifying functional foods as
tional caffeine. The findings demonstrated that caffeine augmen-
potential modifiers of this disease prevalence an invaluable
tation leads to faster encoding and enhanced information
endeavor.
acquisition. Ingesting this high-caffeine coffee improved encod-
Researchers have investigated whether green coffee bean
ing of new information and counteracted the fatigue that devel-
extract (GCBE), which is rich in chlorogenic acid, may be just such
oped over the test session.37
a disease modifier. In one study, two groups were created with 10
The antifatigue properties of caffeine are well-documented
people ingesting a green coffee bean extract and 10 ingesting a
among both bus drivers and airline pilots and coffee has been
placebo drink for 4 months. At the end of the study, the treatment
documented to improve safety when discontinuing such activi-
group experienced significant decreases in total plasma homocys-
ties is not an option.38,39

---

10
ALTERNATIVE & COMPLEMENTARY THERAPIES—FEBRUARY 2006
Beyond improving learning and information accessing capaci-
Coffee and Gastrointestinal and Liver Health
ties, there is evidence that drinking coffee can help improve
mood as well.40,41 The findings of at least one study pointed to
The effects of coffee on the gastrointestinal (GI) tract, the liver,
an inverse correlation between caffeine consumption and suicidal
and the biliary tract are well-documented and have been attribut-
ideation, although coffee is not being suggested as a suicide-
ed to the effects of caffeine and chlorogenic and caffeic acids.
intervention technique.
The effects of coffee as a laxative and digestive aid within the
GI tract are triggered either directly or indirectly by the release of
Coffee and Diabetes
gastrin and other GI hormones.55 Maintaining regular bowel
movements is itself protective against GI disease; in addition,
As early as the 1970s, research has documented a link between
specific studies have demonstrated other potential protective
increased coffee consumption and reduced plasma glucose lev-
effects of coffee for reducing the risk of serious overt disease pro-
els.42 A study conducted in Japan demonstrated an inverse associ-
cesses, such as alcohol-induced pancreatitis.56 Another clinically
ation between coffee drinking and the prevalence of fasting
significant application for coffee appears to arise from its ability
hyperglycemia.43 More recent stud-
to help inhibit both alcoholic and
ies have shown that coffee con-
nonalcoholic liver cirrhosis.57,58
sumption protects women from the
Because of the unique relationship
Several studies have shown that coffee
development of diabetes44 and fur-
between caffeine and the hepatic
ther studies have shown that there is
microsomes that metabolize it, it has
consumption can decrease the incidence
a statistically lower risk of develop-
been proposed that fasting plasma
ing type 2 diabetes with long-term
caffeine concentration may serve as a
or risk of Parkinson’s disease.
coffee consumption.45
guide to measuring the physiologic
Studies conducted in Sweden
impairment arising from chronic
showed that coffee consumption
liver disease.59 By inducing phase 1
improved insulin sensitivity in elderly nondiabetic men46 and
detoxification, caffeine can provide, via hepatic detoxification test-
reduced the risk of both type 2 diabetes and impaired glucose
ing, information on whether an imbalance between phase 1 and
tolerance in men and women who drank 5 or more cups per
phase 2 detoxification pathways are present.
day.47
The unique physiologic impact of caffeine in the liver has also
What is especially interesting is the investigation into the role
led to research on the relationship between serum ?-glutamyl-
of coffee as a potential modulator of the expression of genetic fac-
transferase—a measure of liver damage—and smoking that sug-
tors that might impart a tendency toward developing diabetes.
gests coffee may help mitigate some of the damage associated
Twin studies have shown that, if one twin consumes moderate
with smoking.60 What also supports this trend is an observation
amounts of coffee while the other twin consumes low levels, the
of an increase in ?-glutamyltransferase in women from Norway
twin consuming more coffee has a higher level of protection
who decreased their consumption of boiled coffee.
against developing diabetes.48
Finally, gallstone formation may be modified by coffee con-
Maintaining lean body mass is an important clinical factor in
sumption according to a study of 46,008 men, ages 40–75, in which
helping individuals with diabetes control glucose levels and
those who consumed 2–3 cups of coffee per day had a lower risk of
helping patients with prediabetes gain control over otherwise-
forming gallstones.61 It is noteworthy that all brewing techniques
precarious blood sugar levels.
produced a reduction in incidence of stone formation, as long as
Coffee, in addition to its other protective properties, has been
the coffee had not been decaffeinated. It has also been shown that
found to increase metabolic rates in both obese and nonobese
drinking caffeinated coffee decreases the risk of symptomatic gall-
individuals, with significant metabolic increases in both
stones in women but this has not been demonstrated in men.62
groups.49 A study of lean women demonstrated that coffee con-
sumption increases thermogenesis and lipid oxidation.50 There is
Coffee, Parkinson’s Disease, and Other
also evidence of increased metabolic rates when coffee is con-
Neurologic Conditions
sumed with the first morning meal.51
Yet another study has identified an increase in skin tempera-
Several studies have shown that coffee consumption can
ture and caloric expenditure with coffee consumption.52 When
decrease the incidence or risk of Parkinson’s disease. Indeed,
coffee and exercise are combined, there is a higher lipolytic
evidence exists for protection against the incidence of Parkin-
response compared to exercise alone.53 There is also growing evi-
son’s disease in Asian-Americans63 as well as in the general
dence in the literature demonstrating the ability of both caffeine
population in the United States,64 Italy,65 and China.66 Addi-
and methylxanthine to make a positive impact on cellular
tional studies support findings that coffee consumption lowers
metabolic rates.54
the risk of Parkinson’s disease.67
These findings have been applied broadly in the weight-loss-
With an ever-increasing number of cases of Alzheimer’s dis-
supplement industry and are likely to become applied increas-
ease being diagnosed, interest in ways to mitigate this devastat-
ingly as other popular herbal thermogenic substances have been
ing illness is quite high. It appears that coffee might very well be
removed from the market.
the beverage of choice in this instance as well, as it has been asso-

---

ALTERNATIVE & COMPLEMENTARY THERAPIES—FEBRUARY 2006
11
ciated with a reduced risk of Alzheimer’s disease.68,69 However,
We know that consistent dosing provides a level of clinical pre-
currently, there is a lack of evidence that coffee slows nonspecif-
dictability, whether this involves standard drug therapies, nutri-
ic, age-related mental decline.
tional interventions, botanicals, or functional foods. If we are to
There appears to be a synergistic effect between coffee and anti-
encourage the use of functional foods as tools in overall diet and
convulsant therapy, when used together, that results in a reduction
lifestyle modifications, attempts must be made to provide consis-
of sleep seizures.70 However, this is not advisable for all patients
tent quality and therapeutic bioactivity.
with seizure disorders, because individual tolerences vary.
Conclusions
Coffee and Sexual Activity
Coffee is important for helping to sustain human health. Yet,
A healthy sexual response is achieved when proper neurolog-
if we are to prescribe coffee as a therapeutic intervention, it is
ic, cardiovascular, hormonal, and mental health is maintained.
essential that we understand its dynamic constituent profile
Common hormonal denominators for both men and women rel-
better. It is even more important to note that, because current
ative to sexual desire and response are total- and free-testos-
scientific research has yet to determine the best across-the-
terone levels. It has been reported that total testosterone is
board method to achieve maximum therapeutic efficacy, coffee
positively associated with coffee consumption in men71 and that
remains a food best consumed in its purest, most natural form.
drinking at least 1 cup of coffee per day increases sexual activity
The epidemiologic studies that identify the most effective mix
in elderly women and higher potency has also been reported in
of coffee, diet, and lifestyle are providing us—as clinicians—with
elderly men.
the most useful information as we seek to modify disease expres-
sion in our patients.
Miscellaneous Biogenic Amines
There is a tremendous movement to help make the production
of coffee a sustainable industry, and proposed guidelines for this
The variability seen in the chemical profiles of coffee,
endeavor seek to encourage the consumption of coffee that is
depending on the amount of roasting and the brewing tech-
shade-grown, organic, and fairly traded. To use coffee actively as
nique used, cannot be overemphasized. As researchers continue
medicine is to adhere to the guidance of Hippocrates, who stated
to investigate the bioactive substances in coffee, these investiga-
in 400 BC: “May your food be your medicine and your medicine be
tors have brought to the forefront a series of biogenic amines
your food.”
?
that become particularly prominent during the roasting process,
such as serotonin, spermidine, and agmatine.12 The efficacies
and therapeutic applications of these biogenic amines have not
References
yet been explored thoroughly but may lead to an entirely
1. Specialty Coffee Association of America (SCAA). SCAA 1999 Market
Report. California, 1999.
renewed appreciation of coffee’s transcultural appeal to human-
2. National Coffee Association (NCA). NCA Coffee Drinking Trend Sur-
ity as a whole.
vey. New York, 2000
3. Hasler CM. The changing face of functional foods. J Am Coll Nutr
2000;19(suppl):499–506.
Caffeine
4. Minamisawa M, Yoshida S, Takai N. Determination of biologically
active substances in roasted coffees using diode-array HPLC system.
No discussion on coffee would be complete without at least a
Anal Sci 2004;20:325–328.
brief review of caffeine. Until recent years, the word coffee was
5. Casal S, Oliveira MB, Alves MR, Ferreira MA. Discriminate analysis of
synonymous with caffeine. The scientific literature has attributed
roasted coffee varieties for trigonelline, nicotinic acid, and caffeine con-
to caffeine coffee’s ability to enhance mental alertness, reduce
tent. J Agric Food Chem 2000;48:3420–3424.
fatigue, and enhance wakefulness.72 This review of the benefits of
6. Adrian J, Frangne R. Synthesis and availability of niacin in roasted cof-
coffee has not focused on the benefits of caffeine specifically sim-
fee. Adv Exp Med Biol 1991;289:49–59.
7. Santos EE, Lauria DC, Porto da Silveria CL. Assessment of daily intake
ply because an entire separate treatise would be necessary to do
of trace elements due to consumption of food stuffs by adult inhabitants
justice to the topic.
of Rio de Janeiro city. Sci Total Env 2004;327:69–79.
It is important to realize that because caffeine is a well-known
8. Astier-Dumas M, Gounelle de Pantanel H. Some nutritional aspects of
and documented biomarker in coffee research, the frequent large
coffee [in French]. Arch Sci Med 1974;131:18–23.
variations in levels of caffeine in prepared coffee serves as a point
9. Impellitteri CA, Allen HE, Lagos G, McLaughlin MJ. Removal of solu-
ble Cu and Pb by the automatic drip coffee brewing process: Application
for consideration. The typical caffeine content in coffee ranges
to risk assessment. Hum Ecol Risk Assess 2000;6:313–322.
from 58 to 259 mg per dose.
10. Stavric B, Klassen R, Watkinson B, et al. Variability in caffeine con-
In one study, the mean caffeine content for a 16-ounce cup of
sumption from coffee and tea: Possible significance for epidemiological
coffee was 188 mg per dL.73 There is an equally high variance in
studies. Food Chem Toxicol 1988;26:111–118.
caffeine content reflected in a more recent study that shows a caf-
11. Kubo Shlonsky A, Klatsky AL, Armstrong MA. Traits of persons who
drink decaffeinated coffee. Ann Epidemiol 2003;13:273–279.
feine concentration range of 259–564 mg per dose in the same
12. Cirilo MPG, Coelho AFS, Araujo CM, et al. Profile and levels of bioac-
coffee beverage obtained from the same outlet on 6 consecutive
tive amines in green and roasted coffee. Food Chem 2003;82:397–402.
days.74 Thus, the question must be posed: What other active con-
13. Urgert R, de Groot CP. Consumption of unfiltered coffee brews in
stituents varied within those same samples?
elderly Europeans. Eur J Clin Nutr 1996;50:101–104.

---

12
ALTERNATIVE & COMPLEMENTARY THERAPIES—FEBRUARY 2006
14. Namba T, Matuse T. A historical study of coffee in Japanese and
39. Sparco P. Combating fatigue to enhance safety. Aviat Week Space
Asian countries: Focusing the medicinal uses in Asian traditional
Technol 1996;145:53–55.
medicines. Yakushigaku Zasshi 2002;37:65–75.
40. Quinlan P, Lane J, Aspinall L. Effects of hot tea, coffee and water
15. Dogasaki C, Shindo T, Furuhata K, Fukuyama M. Identification of
ingestion on physiological responses and mood: The role of caffeine,
chemical structure of antibacterial components against Legionella pneu-
water and beverage type. Psychopharmacology 1997;134:164–173.
mophilia in a coffee beverage. Yakugaku Zasshi 2002;122:487–494.
41. Kawachi I, Willett WC, Colditz GA, et al. A prospective study of cof-
16. Daglia M, Papetti A, Dacarro C, Gazzani G. Isolation of anti-bacteri-
fee drinking and suicide in women. Arch Intern Med 1996;156:521–525.
al components from roasted coffee. J Pharm Biomed Anal 1998;18:
42. Naismith DJ, Akinyanju PA, Szanto S, Yudkin J. The effect in volun-
219–225.
teers of coffee and decaffeinated coffee on load glucose, insulin, plasma
17. Daglia M, Tarsi R, Papetti A, et al. Antiadhesive effect of green and
lipids and some factors involved in blood clotting. Nutr Metab 1970;12:
roasted coffee on Streptococcus mutans adhesive properties on saliva coat-
144–151.
ed hydroxyapatite beads. J Agric Food Chem 2002;50:1225–1229.
43. Isogawa A, Noda M, Takahashi Y, et al. Coffee consumption and risk
18. Nicoli MC, Anese M, Parpinel M. Influence of processing on the
of type 2 diabetes mellitus. Lancet 2003;361:703–704.
antioxidant properties of fruits and vegetables. Trends Food Sci Technol
44. Rosengren A, Dotevall A, Wilhelmsen L, et al. Coffee and incidence of
1999;10:94–100.
diabetes in Swedish women: A prospective 18 year follow-up study. J
19. Nicoli MC, Anese M, Manzocco L, Lerici CR. Antioxidant properties
Intern Med 2004;255:89–95.
of coffee brews in relation to the roasting degree. Lebens Wiss Technol
45. Salazar-Martinez E, Willett WC, Ascherio A, et al. Coffee consump-
1997;30:292–297.
tion and risk for type 2 diabetes mellitus. Ann Intern Med 2004;140:1–8.
20. Manach C, Scalbert A, Morand C, et al. Polyphenols: Food sources
46. Arnlov J, Vessby B, Riserus U. Coffee consumption and insulin sensi-
and bioavailability. Am J Clin Nutr 2004;79:727–747.
tivity. JAMA 2004;291:1199–1201.
21. Borrelli RC, Esposito F, Napolitano A, et al. Characterization of a new
47. Agardh EE, Carlsson S, Ahlbom A, et al. Coffee consumption, type 2
potential functional ingredient: Coffee silverskin. J Agric Food Chem
diabetes and impaired glucose tolerance in Swedish men and women. J
2004;52:1338–1343.
Intern Med 2004;255:645–652.
22. Yen WJ, Wang BS, Chang LW, Duh PD. Antioxidant properties of
48. Carlsson S, Hammar N, Grill V, Kaprio J. Coffee consumption and
roasted coffee residues. J Agric Food Chem 2005;53:2658–2663.
risk of type 2 diabetes in Finnish twins. Int J Epidemiol 2004;33:1–2.
23. Olthof MR, Hollman PCH, Katan MB. Chlorogenic acid and caffeic
49. Acheson KJ, Zahorska-Markiewicz B, Pittet P, et al. Caffeine and cof-
acid are absorbed in humans. J Nutr 2001;131:66–71.
fee: Their influence on metabolic rate and substrate utilization in normal
24. Esposito F, Morisco F, Verde V, et al. Moderate coffee consumption
weight and obese individuals. Am J Clin Nutr 1980;33:989–997.
increases plasma glutathione but not homocysteine in healthy subjects.
50. Bracco D, Ferrarra JM, Arnaud MJ, et al. Effects of caffeine on energy
Aliment Pharmacol Ther 2003;17:595–601.
metabolism, heart rate, and methylxanthine metabolism in lean and
25. Panzella L, Napolitano A, d’Ishchia M. Oxidative conjugation of chloro-
obese women. Am J Physiol 1995;269:671–678.
genic acid with glutathione: Structural characterization of addition products
51. Zahorska-Markiewicz B. The thermic effect of caffeinated and decaf-
and a new nitrite-promoted pathway. Bioorg Med Chem 2003;11:4797–4805.
feinated coffee ingested with breakfast. Acta Physiol Pol 1980;31:17–20.
26. Morales FJ, Jiminex-Perez S. Peroxyl radicals scavenging activity of
52. Tagliabue A, Terracina D, Cena H, et al. Coffee induced thermogene-
melanoidins in aqueous systems. Eur Food Res Technol 2004;218:515–520.
sis and skin temperature. Int J Obes Relat Metab Disord 1994;18:537–541.
27. Radtke J, Linseisen J, Wolfram G. Phenolic acid intake of adults in
53. Mougios V, Ring S, Pettidou A, Mikolaidis MG. Duration of coffee-
Bavarian subgroup of the national food consumption survey. Z
and exercise-induced changes in fatty acid profile of human serum. J
Ernahrungswiss 1998;37:190–197.
Appl Physiol 2003;94:476–484.
28. Pulido R, Hernandez-Garcia M, Saura-Calixto F. Contribution of bev-
54. Nehlig A, Derby G. Caffeine and sports activity: A review. Int J Sports
erages to the intake of lipophilic and hydrophilic antioxidants in the
Med 1994;15:215–223.
Spanish diet. Eur J Clin Nutr 2003;57:1275–1282.
55. Ckok G. Coffee and health. Z Ernahrungswiss 1977;16:248–255.
29. Svilaas A, Sakhi AK, Andersen LF, et al. Intakes of antioxidants in cof-
56. Morton C, Klatshky AL, Udaltsova N. Smoking, coffee and pancreati-
fee, wine, and vegetables are correlated with plasma carotenoids in
tis. Am J Gastroenterol 2004;99:731–738.
humans. J Nutr 2004;134:562–567.
57. Klatsky AL, Armstrong MA. Alcohol, smoking, coffee and cirrhosis.
30. Schwartz J, Weiss ST. Caffeine intake and asthma symptoms. Ann
Am J Epidemiol 1992;136:1248–1257.
Epidemiol 1992;2:627–635.
58. Gallus S, Tavani A, Negri E, La Vecchia C. Does coffee protect against
31. Santos RM, Lima DR. Coffee as a medicinal plant and vitamin source
liver cirrhosis? Ann Epidemiol 2002;12:202–205.
for smokers. Int J Chest Dis 1989;43:56–58.
59. Wahllander A, Renner E, Preisig R. Fasting plasma caffeine concentra-
32. Ochiai R, Jokura H, Suzuki A, et al. Green coffee bean extract
tion: A guide to the severity of chronic liver disease. Scand J Gastroen-
improves human vasoreactivity. Hypertense Res 2004;27:731–737.
terol 1985;20:1133–1141.
33. Yukawa GS, Mune M, Otani H, et al. Effect of coffee consumption on
60. Nakanishi N, Nakamura K, Makajima K, et al. Coffee consumption
oxidative susceptibility of low-density lipoproteins and serum lipid lev-
and decreased serum gamma-glutamyltransferase: A study of middle-
els in humans. Biochemistry 2004;69:70–74.
aged Japanese men. Eur J Epidemiol 2000;16:419–423.
34. Richardson T, Rozkovec A, Thomas P, et al. Influence of caffeine on
61. Leitzmann MF, Willett WC, Rimm EB, et al. A prospective study of
heart rate variability in patients with long standing type I diabetes. Dia-
coffee consumption and the risk of symptomatic gallstone disease in men.
betes Care 2004;27:1127–1131.
JAMA 1999;281:2106–2112.
35. Tieges Z, Richard Ridderinkhof K, Snel J, Kok A. Caffeine strengthens
62. Leitzmann MF, Stampfer MJ, Willett WC, et al. Coffee intake is associ-
action monitoring evidence from error related activity. Brain Res Cogn
ated with lower risk of symptomatic gallstone disease in women. Gas-
Brain Res 2004;21:87–93.
troenterology 2002;123:1823–1830.
36. Papadelis C, Kurido-Papadeli C, Vlachogiannis E, et al. Effects of
63. Abbott RD, Webster Ross G, White LR, et al. Environmental, lifestyle
mental work load and caffeine on catecholamines and blood pressure
and physical precursors of clinical Parkinson’s disease: Recent findings
compared to performance variation. Brain Cogn 2003;51:143–154.
from Honolulu-Asia Aging Study. J Neurol 2003;250:30–39.
37. Smith AP, Clark R, Gallagher J. Breakfast cereal and caffeinated cof-
64. Ascherio A, Zhang SM, Hernan MA, et al. Prospective study of caf-
fee: Effects on working memory, attention, mood, and cardiovascular
feine consumption and risk of Parkinson’s disease in men and women.
function. Physiol Behav 1999;67:9–17.
Ann Neurol 2001;50:56–63.
38. Rey de Castro J, Gallo J, Loureiro H. Tiredness and sleepiness in bus
65. Ragonese P, Salemi G, Morgante L, et al. A case control study of
drivers and road accidents in Peru: A quantitative study. Rev Panam
cigarette, alcohol, and coffee consumption preceding Parkinson’s disease.
Salud Pub 2004;16:11–18.
Neuroepidemiology 2003;22:297–304.

---

ALTERNATIVE & COMPLEMENTARY THERAPIES—FEBRUARY 2006
13
66. Tan EK, Tan C, Fook-Chong SM, et al. Dose dependent protective
73. Bell LN, Wetzel CR, Grand AN. Caffeine content in coffee as influ-
effect of coffee, tea and smoking in Parkinson’s disease: A study in ethnic
enced by grinding and brewing technique. Food Res Intern 1996;29 85–89.
Chinese. J Neurol Sci 2003;216:163–167.
74. McCusker RR, Goldberger BA, Cone EJ. Caffeine content of specialty
67. Ross GW, Abbott RD, Petrovich H, et al. Association of coffee and caf-
coffees. J Anal Toxicol 2003;7:520–522.
feine intake with the risk of Parkinson’s disease. JAMA 2000;283:2674–2679.
68. Heuser I. Prevention of dementia: State of the art. Stsch Med Wochen-
schr 2003;128:421–422.
69. Lindsay J, Laurin D, Verreault R, et al. Risk factors for Alzheimer’s
Chris D. Meletis, N.D., is a naturopathic doctor at Beaverton Naturo-
disease: A prospective analysis from the Canadian Study of Health and
pathic Medicine, an integrative medicine clinic in Portland, Oregon, and
Aging. Am J Epidemiol 2002;256:445–453.
an associate professor of natural pharmacology at the National College of
70. Feijoo M, Bilbao J. Seizures of sleep onset: Clinical and therapeutic
Naturopathic Medicine, also in Portland.
aspects. Clin Neuropharmacol 1992;15:50–55.
71. Svartberg J, Midtby M, Bonaa KH, et al. The associations of age,
lifestyle factors and chronic disease with testosterone in men: The Trom-
To order reprints of this article, write to or call: Karen Ballen, ALTERNA-
so Study. Eur J Endocrinol 2003;149:145–152.
TIVE & COMPLEMENTARY THERAPIES, Mary Ann Liebert, Inc., 140
72. Harland BF. Caffeine and nutrition. Nutrition 2000;16:522–526.
Huguenot Street, 3rd Floor, New Rochelle NY 10801, (914) 740-2100.

---